Inspection on 17/08/06 for Burnham House

This inspection was carried out on 17th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Burnham House 12/01/06

Burnham House 10/08/05

Burnham House 31/12/04

Burnham House 14/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Burnham House 401 Cranbrook Road Ilford Essex IG1 4UL Lead Inspector Stanley Phipps Key Unannounced Inspection 17th August to 4 September 2006 10:30 th Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burnham House Address 401 Cranbrook Road Ilford Essex IG1 4UL 020 8518 0707 020 8554 6066 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.achuk.com Consensus Healthcare Limited Mrs Linda Isobelle Davies Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2006 Brief Description of the Service: Burnham House is a care home providing personal care and accommodation for up to eight adults (18-65) with learning difficulties. The home provides a service to both men and women. It was previously owned Aitch Care Homes Limited and as of February 2006 was taken over by Consensus Healthcare Limited. They (Consensus) manage the service and accepts service users on the basis that they meet the homes criteria for admission. The home is located opposite Valentines Park in Ilford and is well served by public transport and is proximate to the Ilford Town Centre, Gants Hill and Ilford train stations. There are a range of cafes, restaurants, shops and amenities that are easily accessible to service users. The home was opened in 2002 and consists of a large and newly refurbished two-storey building, which is indistinguishable from other properties in and around it. There is a reasonably sized and wellmaintained rear garden, which is easily accessible to all service users. All bedrooms are single with two containing en-suite facilities situated on the ground floor. The home is supported by staff on a twenty-four hour basis that work closely with service users in developing their personal/living skills, confidence and self esteem by increasing their presence in community living. Service users are assisted to be actively involved in the running of the home by choosing what they would like to do, what they would like to eat, the type of leisure and educational activities they engage in and generally how they would like to spend their life. The home is geared towards enabling each service user to access healthcare, leisure, spiritual and recreational pursuits in line with their individual choices. A statement of purpose is made available to all service users in the home and is kept in the main Office. Given the level of disabilities service users are likely to have, this document is also made available to relatives and stakeholders. A service user guide is also given to each service user upon admission to the home. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 5 Fees for the services provided range from £1322.76 to £2,056.92 per week. At present there are no additional charges, despite the change of ownership. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service for the inspection year 2006/2007. This meant that all key standards were covered as well as any other standard for which a requirement was made at the last inspection. The visit was done over two days beginning at 10.30 a.m. on the 17/8/06 and ended on the 4/9/06, which was the last day of the inspection. It was spread over this period to ensure meeting with as much of the staff, service users and relatives. At the time of the visit the home had one vacancy and was still operating in some respects under the policy and procedural guidelines of the previous provider- ACH. Consensus was just about starting to introduce their systems in running the establishment and so the home was going through a transitional period. Service users were not adversely affected by the changes, although there are problems in ensuring that the environment is adequately maintained. This could be evidenced from the fact that a number of areas marked for improvement at the last inspection, were not undertaken. The inspection found that the home was generally managed to good effect with the management and staff working towards improving outcomes for service users. There were small pockets of staffing issues in the home, which could have been dealt with more effectively to minimise the discomforts felt by the individuals involved. More support was required from senior management in this respect. As part of the inspection three service users’ files were assessed. The inspector interviewed two members of staff including one of the assistant managers and a service user. Discussions were also held with the manager and up to three service users. A number of records held by the home – were also assessed. Care practice was observed throughout the inspection. This report also took into consideration the result of an interview with a social care professional. The inspection concluded with a tour of the environment. It was noted that all of the improvements to the environment were not carried out, despite the length of time given to achieve them. The registered manager informed that she had been chasing the area manager about these works. The Commission views the failure to meet repeated requirements seriously, as they may adversely impact upon the welfare of service users. It is for this reason that the Commission may commence enforcement action to achieve compliance. What the service does well: Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 7 The service at Burnham continues to ensure that individuals are supported to pursue their aspirations and personal goals as far as they wanted to. This is enabled through a committed effort by staff and is identified through an individual service user’s assessment of needs. It is usually well documented. Meals provided by the home have remained satisfactory, as the home provides varied diets by encouraging choice. This also takes into consideration the cultural preferences of the service user group. Another positive aspect of the service is in relation to retaining and developing staff, which has a positive impact on the welfare of service users in that it ensures continuity of care to the service. The registered persons continued to demonstrate that they are prepared to take action whether it is to support staff to improve in their practice or to take the necessary steps to stamp out bad practice in home. This ensures that service users remain protected and safe at Burnham House. It was clear from the inspection that the relatives of service users are encouraged to participate in matters that affect the health and welfare of service users, living at Burnham House. This is not only an important aspect of the homes operations, but an invaluable one to the service user group, as given their disability, they could easily become isolated. The new providers have continued to provide monthly reports to the Commission reporting on the operations of the home. This is positive as it provides a good opportunity for them to meet with staff, service users and relatives where possible. It is also a vital monitoring and a quality assurance tool that could enhance the quality of the overall service provision at Burnham House. The registered manager continued to work with the Commission to ensure that the quality of service provision improves by ensuring compliance with requirements set on the home. This is a positive outcome for all service users living at Burnham House. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (1,2) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are assured that their needs would be catered for by the thorough assessments that are carried out by the home. However they should also have the benefit of having updated information in relation to the home. EVIDENCE: All service users are given a copy of the service user’s guide and a statement of purpose is made available to them via their notice board with copies also available in the staff office. This is useful, as some service users tend to access the staff office more so than others. There have been changes in relation the registered providers and though relatives and some service users were aware of this fact – the service user guide did not reflect the key changes. This document referred to ACH and the NCSC. It also makes reference to the sensory room as a room where relatives could stay overnight – which is no longer the case. This document needs to be reviewed and updated to reflect the current position in the home. At the time of the visit there had been no new admissions to the home and detailed assessments remained on the files of all service users currently living in the home. They were carried out in conjunction with service users and the placement authorities and remains key to determining the suitability of the home for meeting the needs and aspirations of service users. The home’s admissions procedure remains sound, although it has not been used over the last year. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 11 Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (6,7,9) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users needs and choices are documented in their service user plan and well catered for. They benefit from the input of staff in making decisions about their life and this includes the risks they take. Individual risk management in the home ensures service user safety. EVIDENCE: As part of case tracking two, service user files were examined and they all contained individual service user plans in them. They covered the personal, social and healthcare needs of the individuals concerned and there was evidence that relatives were involved in the process of service user planning, which is positive. The service user plans took into consideration the individual requirements as assessed by the home, in conjunction with the care management information provided by the placement authority. There was evidence of a review that was held for one of the service users on the 26/4/06 and the outcomes were clearly documented for the service user concerned. Feedback received from a social care professional conducting a review during the visit, indicated that although it was her first time – she was satisfied with the way the review was handled. In describing her experience she stated – ‘the staff were effective in engaging the service user – whilst giving him choice’. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 13 Staff continued to work closely with service users in enabling them to make decisions about their life. A good example could be drawn from the fact that one service user did not wish to pursue college and preferred to gain employment. Staff supported the individual to access the job centre to achieve his goal. It turned that he required further training, but did not wish to engage with this either. Staff were happy to explore other alternatives with him and this is positive. He uses the internet in the home in a structured way and enjoys typing, which is encouraged. Another service user wished to explore horse riding and she had an assessment and was waiting for a start date. As part of promoting a safe environment and service user independence, risk assessments were in place for all service users. They were updated and developed within the risk management framework of the home. One example could be drawn from the fact that one service user relishes his independence and has taken a dislike to going out as part of a group. Sound arrangements were in place to ensure that he is given the support to achieve this. He goes out to Barkingside and has his hair cut and this is again a positive outcome for the individual. Risk assessments were individually undertaken, taking into consideration the aspirations, skills and abilities of each service user. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (12,13,15,16,17) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from being engaged in activities they choose and generally enjoy. They are actively involved with their community and this is complimented by strong links that are maintained with relatives. The management and staff promote both the individuality and rights of service users. Meals are generally of a good standard and meet the nutritional requirements of individuals in the home. EVIDENCE: There was evidence that the management and staff worked with service users in supporting them to take part in activities on an individual basis. Each service user has a programme of activity and this is based on choice, ability, interest and cultural preferences. Some individuals enjoy using a sensory room and would be encouraged to use one in the home or taken out to as far as Walthamstow for the experience. Another enjoyed bingo and gets out on a monthly basis to experience this. Some service users also enjoy going to church and staffing arrangements are put in place to ensure that they attend when they want to. They also go out as a group and one of the most recent trips was to Dover Castle courtesy an Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 15 organisation known as the Eastenders. Two service users spoken to recalled the experience as a pleasant one. One service user went to Weymouth Caravan for a weekend and plans were made for another to have a similar experience. Other holidays planned for individual service users included trips to York, Ireland and Centre Parcs. This is a strong area of the homes operations. Service users have opportunities to actively engage in community life and this is undertaken individually and/or collectively. Some individuals were involved in swimming, getting out to the shops and the local park while others prefer a drive out into the community. In other cases service users enjoy going out to the cinema. Most of the service users in the home have been there for some time and is well settled in the home and have a good sense of community awareness. This has been made possible through the concerted efforts of the management and staff. In speaking with one service user he indicated that he wished to go out to the transport museum in Convent garden to have lunch and staff were supporting the individual to achieve this. At Burnham House there was strong evidence that the relatives of service users are involved in promoting their welfare. This included involvement in planning outcomes for them with regard to their health, personal, spiritual, physical and social development. There was evidence that a service user spends at his choosing, an overnight with a friend who knew since he was young. There were cases in which relatives are involved in reviews for service users. Staff took a service user to Southend where she met her relatives, encouraged another to keep contact with his relative by phone and supported him to visit the graveside of his mother. Evidence was provided informed that one service user goes from time to time with her relatives to the temple to fulfil her religious obligations. Feedback from two relatives indicated that the home keeps them informed and involved – and they were pleased with this. This is a strong area of the homes operations. Three members of staff were interviewed and were aware of the General Social Care Council’s code of conduct in promoting the rights of service users. They were observed addressing service users by preferred names, knocking on their doors before entering and generally providing individualised person centred care. In some cases the relatives of service users advocate on their behalf, but the registered manager has identified MENCAP to provide advocacy services to those that might need it. At the time of the inspection service users were not accessing advocacy services. Meals and menus were assessed over a four-week period and were nutritionally balanced, taking into consideration the individual and cultural preferences of service users. Based on their religion at least two service users were not given beef and/or pork, which is positive. There was evidence that another service user is supported to maintain a low-salt diet and all staff were aware of the risks to the individual’s health. They were proactive at involving both the GP and the consultant in working along with the service user to Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 16 achieve a healthy lifestyle. Staff are working creatively with the individual, to ensure that their involvement did not compromise his independence. Most of the staff have had basic food hygiene training. The meal for the day included mince, mash and vegetables with one service user preferring tuna as opposed to the mince. From observation service users were happy with their meals. The staff team is diverse and this allows service users who wished to have African food – to have the opportunity to so do. The manager gave an example of a Kenyan born staff, that is able to provide such meals and this is positive. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (18,19,20) Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. Service users enjoy personal support in accordance with their needs and wishes and the staff team is proactive in ensuring that both their physical and emotional needs are met Medication practices in the home ensure the safety of service users requiring support with medication. EVIDENCE: Service users follow their individual plan and are encouraged to work with staff in providing personal support to them. This is important as the range of special needs of the service user group is quite varied and as such, would be best provided in line with the preferences of each individual. The staffing deployment continued to take full account of this and every effort is made while providing the support – to promote and maintain service user independence. Service users wear their own clothes and have their individual and distinct way of dressing. Discussions held with service users and staff indicated that they were pleased with the how personal support was provided in the home. Feedback from relatives and external professionals indicated that the staff were flexible and preserved the dignity of individuals living in the home. The key-worker system is used to ensure the monitoring and coordination of outcomes for service users. Despite the varying levels service user’s abilities, there were growing Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 18 levels of confidence and self-esteem among service users and this is positive. One service user had a preference for female staff to provide personal care and this was provided. There was also evidence that the physiotherapist was involved with regard to the individual’s mobility and a referral was made to the speech and language therapist to improve her ability to effectively communicate. Up to three visits had been made by the latter thus far for the benefit of the service user concerned. All service users were registered with a GP and records were held on visits made to and by health professionals. This included the use of dentists, opticians and the chiropodist. Staff interviewed showed a good understanding of the needs of all service users, but were also quite knowledgeable about the needs of service users for whom they were key-working. Staff also demonstrated the ability to identify when the health of service users deteriorate. There is also clear policy guidance for staff to follow when these situations arise. Emergency numbers were widely posted in the staff office to acquire further assistance as required. From assessing the files of service users, it became evident that staff knew what they were doing in supporting service users when they become unwell. Medication practice was observed and an assessment of the drug storage and record – undertaken. The staff responsible for medication referred to the drug charts and discharged her responsibilities in a satisfactory manner. None of the service users were capable of self-medicating and so they rely upon the staff to carry out this responsibility in a safe manner, to ensure that their health and welfare is promoted and protected. A satisfactory medication policy and procedure was in place in the home and staff were aware of it. There are key members of staff that have the responsibility for administering drugs and they all have been provided with training in medication. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (22, 23) Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. A satisfactory complaints policy and procedure is available for the benefit of service users and their relatives. Sound procedures were also in place at the home to ensure the protection of service users coming into contact with the service. EVIDENCE: The complaints record was assessed and it appropriately detailed issues investigated by the registered manager. One complaint was pending and this was a staff related issue. There was an unsatisfactory delay in concluding this matter and it was down to lack of direction and support by the senior management in the organisation. However at the time of writing this report the registered manager assured that the issue had been moved on. The service user complaint procedure was updated and remains available on the notice board. Most of the service users are unable to raise complaints independently and rely upon their relatives to assist them. For those who are able to, they stated that they would complain, if they were unhappy with something in the home. From interviews with staff, they viewed complaints as a positive feature in promoting the rights of service users. A satisfactory adult protection procedure remained in place at the home and this includes clear guidance on ‘whistle-blowing’. Most of the staff team had training on adult protection and from interviews held with a random samplethey understood their responsibility in protecting vulnerable adults. There were no adult protection issues in the home. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (24,26,27,30) Quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to the service. Service users generally enjoy living in a comfortable and safe environment. Some improvements to private spaces were carried out, however the comfort of the home is diminished by the failure to maintain a number of areas in the home. EVIDENCE: On the day of the visit the home was clean and accessible to all service users. Some areas however like the kitchen and the main lounge and dining looked dull and was in need of re-decorating, in particular the ceiling of the main lounge. There is maintenance worker attached to the home and carries out works as and when required. The registered persons did not have in place, a planned maintenance and renewal programme for the fabric and decoration of the premises. One is therefore required. Some of the areas noted for improvement included: re-decorating the kitchen dining and lounge areas, replacing or renewing the nest of tables in the main lounge, re-grouting the skirting in the kitchen, renewing the worn cupboard doors and drawer fronts, repairing the hole on the floor outside the dining room door, re-finishing the handrail on the right side stair leading to the first floor and cleaning the windows in the sensory room. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 21 Service users bedrooms were individualised and contained personal effects that they chose. There were some areas that were improved as required by the last inspection report. It is true to say that all service users relished their private spaces and this is positive. However there were also issues of maintenance in this area, some of which included: KP’s room although with a new carpet – needed redecoration, as was JA’s room in which the carpet needed either deep-cleaning or replacing. A replacement strip is also required for the front of her JA’s vanity cupboard. PD’s carpet needed deep-cleaning to remove unsightly stains or if not then it needs to be replaced. Bathroom and toilets remained adequate in number and were generally clean on both visits to the home. They are lockable with an override device to ensure the service user’s privacy and safety. However a number of maintenance issues were identified including: Repairing the damage to the toilet door outside GR’s room, replacing the cracked tiles in the shower room, reviewing the locking mechanism for the said shower room, replacing the bathroom panels and resealing the gaps around the bath and redecorating the downstairs toilet opposite the kitchen. The laundry area was generally satisfactory and this is also used as the staff changing room. The floor surfaces were satisfactory and the equipment is suitable for ensuring infection control in the home. Hand washing facilities were placed throughout the home and this helped to promote hygienic practices. However the laundry area also needed some re-decorative work and more importantly the left handrail on the stairs leading to the basement – needed stabilising. In general the home was in need of ongoing maintenance and this must be addressed by the registered persons. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (32,34,35,36) Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. At Burnham House service users receive care and support from a dedicated and effective staff team. Robust recruitment procedures ensure that service users are safe when engaging with staff. A focussed approach is in place to improve the skills and expertise of staff. Improved supervision for staff provides sound direction, although this could be enhanced further, with staffing appraisals. EVIDENCE: At the time of the inspection fifty-eight per cent of the staff team had achieved their NVQ level 2 in Care. Up to four staff members had gone on to achieve the level 3 award with at least two achieving level 4. Four were due to start their level 2 in the near future. Service users were therefore benefiting from being supported by staff that had a good understanding of basic care. What was promising was that a number of staff were keen to improve their skills and knowledge. From interviews held with three of the staff – they demonstrated a sound knowledge of the service users’ needs and the service aims. They were creative in communicating with service users and as such did so through the use of: objects of reference, pictures and, the individual non-verbal gestures of service users. Five staff attended recently attended ‘conflict management’ training, with plans for the rest of the team to attend. An assessment of the Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 23 service users records indicated that staff were capable of working with the multiple and individual needs of service users. Satisfactory arrangements were in place for robustly screening staff wishing to work in the home. A random sample of four staffing recruitment files were examined and found to be in order i.e. containing all the detail required by regulation e.g. CRB checks, medical declarations, copies of passports and birth certificates and where applicable – the eligibility to work in the United kingdom. In fact there was evidence that three references are now taken up for staff and this is positive. Service users therefore have the assurance that staff working with them are fit to so do. This is confirmed only upon the satisfactory completion of a probationary period, which not only meets the minimum requirements, but also constitutes good recruitment practice. The registered persons continued to recruit a diverse team in terms of gender and ethnicity, which in the interest of the current service user group. It was noted that there was a delay in some staff obtaining a copy of their terms and conditions, but the registered manager was aware and working with the HR department to rectify this. From the interviews held with staff – this did not detract them from providing a quality service. A training needs analysis was carried out for the staff team and training provided in relation to needs. This work was carried out by one of the assistant managers. At the time of the inspection all staff were in the process of updating their mandatory training. Given the challenges posed by service users, staff need to ensure that their interventions are safe. One of the training that has been provided to enable this was entitled - ‘Responses to Physical Provocation’. A local training provider had been recently commissioned to provide training for staff in the home and was due to meet with the manager to look at the current needs of staff. Most of the team welcome the training provided and in rare cases where staff are unwilling to go on training – action is taken to address this. Service users are therefore assured that staff are equipped with the training to meet their needs. There has been an improvement in the support provided to staff as formal supervision was provided more regularly for staff. Staff interviewed felt that it was useful in enabling them to effectively do their jobs. However there was little evidence that staffing appraisals were carried out. This could affect the development of staff in relation to providing quality outcomes for service users. This was discussed with the registered manager and needs to improve. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 24 Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (37,39,40,42,43) Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. A sound management structure is in place at Burnham House to promote welfare and best interests of service users. This includes the quality monitoring of the service. The quality of the service could be enhanced by improving health and safety in the home and ensuring that systems are in place to support the management of the home. EVIDENCE: The registered manager had achieved her NVQ level 4 in Care Award and was due to commence the Registered Manager’s Award in October 2006. She lead a team of assistant managers, senior workers and support staff in her aim to provide care that is service user focussed. She also continued updating her skills and knowledge along with the rest of the management team. At the time of writing this report, the inspector was made aware that the registered manager was leaving the home. Satisfactory interim arrangements have been notified to the Commission, using the current expertise in the home while a permanent replacement is found. Given that she led by example, service users Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 26 are expected to receive a consistent service even with the interim arrangements. There was evidence that service user surveys had been completed out of which an annual development plan was in place for the home. This document set out the objectives for improving the service during the period - 2006/2007. It was important to note that one of the comments made by service users was having more staff and the registered persons have since recruited two more support staff. This is a positive outcome for service users. Another key item in the annual development plan was for better teamwork and out of this it was recognised that training in equalities and diversity was required. The organisation also conducted an internal audit of the service and graded the home as adequate – having identified areas for improvement. This is also positive. There was evidence of regular monthly provider visits in which discussions are held with staff and service users about the service. At the time of the visit the organisation was still going through a transition and as such policies and procedures were being reviewed and replaced. Staff were involved by making comments in the draft stages of the documents. Plans were in place to have most of them in place by October 2006 and this timescale needs to be closely monitored to ensure that this timescale is met. In the meantime some of the existing ACH policies were used. Health and safety in the home has been generally satisfactory with updated records in place. Staff were in receipt of refresher health and safety training and for those that did not have this training – a booking was made for them. Risk assessments regarding health and safety were reviewed and certificates for gas, electric and fire equipment was in date. Fire drills were carried out satisfactorily. However there was one area requiring improvement and it was in relation to food storage. A number of food items were found improperly stored and this poses a risk to service users. At the time of the visit a business and financial plan was not available for inspection. This is required, as there seem to be some delay in carrying out maintenance works in the home. Staff also reported that there was an occasion when the clinical waste bins were not collected due to non-payment of the bill. While this could be due to the implementation of new systems, the inspector could not be certain about this. The home had adequate insurance cover and lines of accountability were now clear to service users and staff. However, there were still unsatisfactory arrangements to formerly supervise the registered manager and a number of examples were provided in cases where staff had to be disciplined. The registered manager informed that she has not been regular formal supervision and as such, she could not provide written evidence of this. This needs to improve particularly now that an acting manager is in post. Evidence that Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 27 formal supervision is provided on a regular basis to the manager- must be in place. Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 3 X 2 2 Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 29 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA1 YA24 Regulation 6(a) (23(2)(b) Requirement Timescale for action 04/11/06 3. YA26 23(2)(d) The registered persons are required to review and update the service user guide. 30/11/06 The registered persons are required to: (1) Redecorate and refurbish the communal areas including bathrooms that are showing signs of wear and tear 2) Carry out all works identified in standard 24 of this report and 3) Develop a programme of maintenance for the fabric and decoration of the home. (Item 1 was part of a previously made requirement. Timescale 30/04/06). The registered persons are 30/11/06 required to carry out all works identified in Standard 26 of this report. The registered persons are required to carry out all the works identified in standard 27 of this report. The registered persons are required to carry out all works identified in Standard 30 of this report. DS0000035127.V309023.R01.S.doc 4. YA27 23(2)(d) 30/11/06 5. YA30 23(2)(d) 30/11/06 Burnham House Version 5.2 Page 30 6. YA36 18(2) The registered persons are required to provide annual appraisals for all staff. The registered persons are required to ensure that food is safely stored in the home at all times. The registered persons are required to ensure that formal supervision is regularly provided to the manager of the home. (This was a previously made requirement – Timescale 18/03/06). The registered persons are required to have in place and available for inspection – a business and financial plan for the home. 31/12/06 7. YA42 13 30/10/06 8. YA43 18(2) 30/10/06 9. YA43 25 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Burnham House DS0000035127.V309023.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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